One of the most talked about topics from the recent State of the Nation Address (SONA) of President Ferdinand Marcos Jr. was the expanded rollout of no-balance billing in Department of Health (DOH) hospitals as part of universal healthcare. There was a lot of discussion on mainstream and social media afterwards, with some critics stating that this was fake news, while others said that no one wanted to go to the DOH hospitals because the conditions there were pretty bad. Others thought that every single public hospital was now obligated to accept no-balance billing, without understanding that not all public hospitals are under the DOH. What is the real score, and how can we achieve true universal healthcare in our time?

No-balance billing, by definition, means that a patient who is seen in a hospital will be cared for and treated without any out-of-pocket costs. At the end of the hospital stay, the patient literally has no balance and will not have to pay for any of the services that were received during the hospitalization. This includes doctors’ fees, diagnostics, as well as medications and other treatments. This is different from pure charity care since the hospitals and doctors actually get paid by Philhealth for each patient. This payment makes the whole enterprise financially viable, provided the case rate reflects the actual average expenses for that specific diagnosis. Managed properly, no-balance billing is sustainable and can increase the quality of care above that of the usual charity level standards.

For DOH hospitals, no-balance billing currently still has a lot of caveats. It only refers to the basic level of service provided by these hospitals and is dependent on the availability of services and treatment in each hospital. For instance, someone who comes into a DOH hospital and expects no balance billing will need to be a Philhealth member. They will be admitted to a regular ward bed, subject to availability. Their doctor will be someone who works for the DOH, and they cannot choose their physician. Medications and laboratory examinations are covered by the Philhealth package as long as these are available in the hospital. If some medications are out of stock, the patient will have to buy them from an outside pharmacy, and this will be an out-of-pocket cost. If certain specialties and subspecialties are not available in the hospital, they may need to be transferred to another hospital (which might not be free) with those capabilities. The aim is to properly equip DOH hospitals with adequate staffing, diagnostics, and medications to cater to the most common illnesses such as pneumonia, dengue, and heart disease, while having regional specialty centers for referral for more complicated cases. This has already been going on for some time now, since the last two administrations, but it is encouraging to see that more and more hospitals are being set up along with specialty centers in the provinces.

Aside from DOH hospitals, some public hospitals also practice no balance billing for a subset of their patients. The Philippine General Hospital (PGH) has a separate Philhealth ward for select cases. This ward has semi-enclosed private beds, which are better than the usual charity beds, and they are seen as private patients by attending physicians affiliated with PGH who agree to accept the Philhealth case rates without any additional co-pay. Some local government hospitals augment the Philhealth case rates with their budget from the LGU to offer upgraded services to patients regardless of their capacity to pay. For instance, there are some LGU hospitals in Mindanao that do not have cashiers precisely because any excess cost beyond the Philhealth case rate is covered by the LGU. Philhealth can still be used in private hospitals like before, but the ceiling of reimbursement is the actual case rate, after which the patient pays for any excess costs, including doctors’ fees.

The idea of universal healthcare is different from charity healthcare. In a charity setting, the services are given for free, and the government spends on everything using taxpayers’ money. There are many horror stories about charity wards in government hospitals, where you can’t even get a bed due to severe overcrowding. In the past, public hospitals had to rely on their budgets to pay for all the care of these patients. Nowadays, government hospitals can augment their budgets with the Philhealth payments for case rates, and this extra funding has enabled them to upgrade their amenities and hire more healthcare personnel. Capacity is still an issue, but more hospitals are on the way. The intention of universal healthcare is to eventually offer a level of care that is on par with private care in terms of decent facilities, competent doctors, and clinical outcomes. This is already happening with the Konsulta packages, where even private healthcare providers are accepting Philhealth for outpatient care at the agreed-upon case rates, along with some laboratory exams. A lot of tweaking still needs to be done, but the partial rollout has been very successful. There will also be less reliance on the use of guarantee letters, which are subject to patronage politics, and on PCSO handouts, which can be subject to kickbacks and corruption. In fact, the budget for guarantee letters and handouts can instead be given to universal healthcare to augment its funds and further improve coverage.

Aside from hospitals, it is essential that universal healthcare gets good buy-in from doctors. Many private doctors are concerned that being forced to accept universal healthcare will cut into their incomes. This isn’t true at all. There is no attempt to force anyone to accept case rates in the private sector as the only form of remuneration. In fact, sometimes the only payment we get from taking care of a private patient is the professional fee from the case rate if the patient is unable to pay. There are more and more salaried medical specialists in government hospitals who take care of patients without charging a separate professional fee. Moreover, the case rate professional fee serves as an additional income source to them as a productivity incentive.

The Universal Healthcare Law, if properly implemented, will provide access to good quality healthcare for all Filipinos. This isn’t charity care because you are actually paying for it with your premiums, and the hospitals and doctors are getting paid for their services. It won’t be luxurious, but the aim is a good standard of care regardless of capacity to pay. With the new Philhealth board increasing case rates and funding for many new services, more and more providers and hospitals are seeing participation in UHC as financially viable and sustainable. This translates into a win-win situation, especially for indigent Filipinos who no longer have to beg politicians for handouts, and can finally get proper healthcare with their dignity intact.